Migraine Medications for Kids

Migraines are common in children. A recent study estimated that almost 8% of children and teens under 20 years have migraines, although some outgrow having them by the time they are adults.

Surprisingly, for these children with migraines, the "mean age at onset is 7 years and 9 months."

Although it is good to know that medications are available to help stop and prevent migraines, these medications certainly aren't a quick fix for most kids.

That makes it important for kids with migraines to also learn to get SMART about their headaches, including that they:

• Get enough sleep each night.
• Don't skip meals.
• Are physically active each day and get some exercise.
• Learn to Relax and reduce stress in their life.
• Avoid migraine triggers.

A headache or symptom diary, in which you record all of the things you did 12 to 24 hours before getting a headache, can sometimes help you find your migraine triggers.

Unless you find a specific migraine trigger though, putting your child on a restrictive migraine diet is probably not a good idea. Except for avoiding caffeine (a good recommendation for all kids), there is probably no good reason for all kids with migraines to avoid aged cheeses, chocolate, luncheon meats, and monosodium glutamate (MSG).

What does your child take when she gets a migraine?

If she is like many kids, she probably just takes some acetaminophen or ibuprofen and toughs it out.

Keep in mind that other helpful treatments for a migraine might include Aleve (naproxen sodium), an alternative for pain control if acetaminophen and ibuprofen aren't working well, and Zofran (ondansetron), to help with nausea and vomiting.

Triptans are the main migraine medications that adults are prescribed to help abort or stop a migraine headache.

Fortunately, a few triptans have been approved for use in children and teens. Axert (almotriptan) is available as 6.25mg and 12.5mg tablets and has been approved for children between the ages of 12 and 17 years. Axert should be taken at the first sign of a severe migraine headache and may be repeated in two hours if a headache returns, with a maximum daily dose of 25mg.

Maxalt (rizatriptan) is another. Available in ODT (oral disintegrating tablets) or regular tablets, it is FDA approved for children between the ages of 6 to 17 years.

Although they aren't formally FDA-approved for use in children and teens, many of the other triptan migraine medications have "strong supporting efficacy and safety data in adolescents," including:

• Imitrex (zolmitriptan)
• Zomig (sumatriptan)

Whatever medication you are using to try and stop your child's migraines, it is usually best to take the medication at the very earliest sign that he is getting a migraine.

Will they stop your child's migraine altogether? Sometimes they do, while other times they just make the headaches less severe so that your child can stay at school and continue to function well.

If your child is getting migraine headaches very frequently, then instead of just trying to treat them when they occur, it might be a good idea to take a daily medication to try and prevent them from happening in the first place.

Preventive migraine medications are especially a good idea if your child has four or more migraines a month that cause a disability, such as missing school or other activities.

These types of preventive migraine medications can include:

• Periactin (cyproheptadine) - given at a dose of 0.25 to 1.5 mg/kg/day or 2 to 8mg/day, this antihistamine has the unfortunate side effect of causing weight gain. On the positive side, it can sometimes cause sedation, which can benefit kids when given at bedtime. It is available as a liquid and pill.
• Elavil (amitriptyline) - this older antidepressant is also usually given at bedtime and can cause weight gain and sedation. Doses usually range between 0.1 to 1 mg/kg/day or 10 to 50mg.
• Topamax (topiramate) - an antiseizure medication that can cause sedation and weight loss. Doses range from 1 to 2mg/kg/day, with a typical adult dose of about 50mg twice a day. Topamax was approved in 2014 for migraine prevention in children and teens between the ages of 12 to 17 in 2014.
• Depakote (valproic acid) - another antiseizure medication that is also used to treat children with mood disorders.

Except for Topamax, none of these other medications are FDA approved for the treatment of chronic migraines, though, and so are used "off-label."

And while they may not make your child's migraines disappear, they will hopefully decrease quite a bit, both in how often they occur and how bad they are.

Other things to know about migraine medications include that:

• Aspirin is included in some combination migraine medications, but it is typically avoided in children and teens because of the risk of Reye's Syndrome.
• Rebound headaches, with an increased number of migraine headaches, can occur if you take non-preventive type headache medications too often. Overusing migraine medication can also make it less likely that your child's daily, Preventive medications will even work. On average, if your child is taking ibuprofen or acetaminophen more than 15 days a month, triptans more than 10 days a month, or combination medications with butalbital as few as 5 days a month, then he is at risk for increased migraines because of medication overuse. He should likely instead be on a better preventive migraine medication regimen.
• Propanol, a beta-blocker, and clonidine, an alpha-adrenergic agonist, are also sometimes used for migraine prevention in teens.
• Opioid type pain medications, like hydrocodone, are usually best avoided when treating kids with recurrent migraine headaches.

Talk to your pediatrician if your child's migraines are getting worse, are changing, or if your child is developing new symptoms with his headaches.

The bottom line though is that with at least three FDA-approved drugs to treat and prevent migraines, pediatricians should be able to do a good job managing kids with migraines. A pediatric neurologist or another headache specialist can also help treat your child's headaches.